Relinquishing Hope of Palliative Care

“RELINQUISHING HOPE OF PALLIATIVE CARE”

by: Madelene O. Lopez, RN

I grew up in a family in which occasional conversations about death occurred at the dinner table. My grandfather openly discussed his own. As a child, this terrified me, but he would say, “It’s a terrible subject, but everyone dies someday.”

I don’t remember how old I was when my grandfather made me promise that he wanted to be exposed in a coffin and his remains be buried down at a faraway place upon his death. It feels like I always knew, and this knowledge comforted me when, a year ago, my sister and I spread flowers to his coffin while burying at a cemetery ground in Laguna.

At first, my grandfather struggled when it came to telling me about death. Starting when I was around three years old, I remember it’s around Christmas time, he would sometimes bring home baby birds that fallen from their nests. He kept an old birdcage for this purpose. He let me name the birds, and I called each of them tweetie. He taught me to mix small pieces of bread with watered-down milk, and then feed

it bit by bit into their disproportionately large mouths with an eyedropper.

This ritual usually lasted two days. On the third morning, I’d wake up to find the cage empty. Every time, I ran into the kitchen where my father drank coffee, crying, “Daddy, tweeti’s gone!” Every time, my father answered, “Sweetheart, Tweetie got strong. I let him go with his friends.” And I would be pleased that my father and I had saved another life. Now, Im 26 years old, visiting my grandfather, I remember saying, “Paps, remember how daddy and I raised all of those baby birds, and let them go, when I was a kid?”

He paused, looking me in the eye. Sweetheart, those baby birds all died. I got up early in the morning, wrapped them in paper towels, and threw them in the garbage before you woke. It’s very hard to save the life of a baby bird. I thought you knew.”

I didn’t know. All those years, I believed the baby birds flew with their friends. I knew my father would die someday, and be buried. I didn’t know my baby birds had died. For my grandfather, it was easier to talk about his own death than to tell his three-year-old her baby birds died. Logically, it makes no sense, but that is often the case with our emotions. We know what we feel, and our emotions force logic to its knees.

Dreaming about becoming an Oncology Nurse,

When death is imminent, it’s not what to do that is in question; it is the when to do if that patients struggles. Having this information available before imminent death provides direction, but does not prevent emotion from leading the charge.

Palliative onco- nursing care has improved enough that many patients enjoy good quality of life even days before death. They are confused when told they are dying. Where are the feeding tubes? Where is the vegetative mental state? Their deaths do not resemble the description found on the advanced directives. They are often more confused, because they do not wish futile care. In my experience, they frequently ask, “When should I stop?”for many, the end is insidious. I have witnessed many express the surprised wonder of a child when told, “You are dying.”

For end - stage terminally ill patients, they will continue to accept and receive treatments beyond logical hope. To accomplish this, palliative care, should become standard of care upon diagnosis of late-stage cancers—not for the purpose of relinquishing hope, but to provide access to a dedicated nursing care provider able to guide and comfort end-.stage of life as Nurse Theorist Carmencita Abaquin's Model.

*The story above is retrieved from Birdcages: An Oncology Nurse on Crucial Information Patients Need About Dying

For more information about oncology nursing, here is a video about the Oncology Nursing Society in the U.S.

ONCOLOGY NURSING SOCIETY

www.currentnursing .com

CONTRIBUTOR: MADELENE LOPEZ, RN